Because of the particular significance of self-image during adolescence, a study was undertaken of two hundred eighty-four men and boys with varying degrees of breast enlargement (nodules, general obesity, and gynecomastia). A group of thirty-one with pendulous gynecomastia during puberty was studied in depth. Those who used the condition as a focus for underlying psychotic or neurotic identity confusion were differentiated from those in whom the reaction seemed predominantly somatopsychic. Combined psychotherapy and reconstructive surgery is recommended for both types unless surgery is contraindicated psychiatrically.